Provider Demographics
NPI:1992255483
Name:STORK & SPROUT LLC
Entity type:Organization
Organization Name:STORK & SPROUT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRITTANY
Authorized Official - Middle Name:
Authorized Official - Last Name:MAALONA
Authorized Official - Suffix:
Authorized Official - Credentials:IBCLC
Authorized Official - Phone:650-455-6024
Mailing Address - Street 1:PO BOX 1657
Mailing Address - Street 2:
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94011-1657
Mailing Address - Country:US
Mailing Address - Phone:650-227-3223
Mailing Address - Fax:
Practice Address - Street 1:400 LOCUST AVE
Practice Address - Street 2:
Practice Address - City:SOUTH SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94080-2614
Practice Address - Country:US
Practice Address - Phone:650-227-3223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-07
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Multi-Specialty
No174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Multi-Specialty